Chapter 12-Wrist and Hand Injuries

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Chapter 12-Wrist and Hand Injuries
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Objectives

• Understand the basic anatomy of the wrist and
  hand.
• Explain various types of injuries that occur to
  the wrist and hand.
• Understand common mechanisms that cause injuries
  to the wrist and hand.
• Understand the signs and symptoms of the various
  types of fractures of the wrist and hand.

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Anatomy
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Anatomy-Carpal Bones

• Some lovers try positions that they cant
  handle
• Scaphoid, Lunate, Triquitral, Pisiform,
  Trapezium, Trapezoid, Capitate, Hamate
• http//www.gwc.maricopa.edu/class/bio201/hand/awri
  st.htm

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Anatomy-metacarpals and phalanges

• Labels 1-5, beginning at thumb
• 5 metacarpals (each hand)
• 14 phalanges (each hand)
• Phalanges classified as proximal, middle and
  distal phalanx

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Anatomy-joints

• Named for the bones that comprise them
• Carpometacarpal (CMC)
• Metacarpal phalangeal (MCP)
• Proximal interphanlageal (PIP)
• Distal interphalangeal (DIP)
• http//www.gwc.maricopa.edu/class/bio201/hand/anha
  nd.htm

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Anatomy-muscles

• flexor groups

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Anatomy-muscles

• Extensors

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Anatomy-hand

• Adductors and Abductors of phalanges

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Anatomy-muscles

• Thenar eminence

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Anatomy-muscles

• Hypothenar eminence

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Anatomy-Ligaments

• Mostly intrinsic due to need for bones to be
  connected
• Radial and ulnar collateral
• Flexor retinaculum or transverse carpal ligament
• Stablizes carpals, covers flexor tendons and
  median nerve

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Anatomy-ligaments

• Thumb
• Ulnar collateral of the thumb
• Radial collateral of the thumb
• Provide joint stability to thumb

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Injuries

• Prevention
• Braces
• Tape
• Gloves
• Padding

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Ligament Injuries

• Wrist sprains
• Often caused by overuse, falls, and forceful
  twisting motion
• Injury side depends on side of twist/overstretch
• S/S- pain, decreased ROM, decreased grip
  strength, possible swelling
• PRICE
• Taping for support
• Rehab focuses on establishing normal ROM and
  return to normal strength

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Dislocated lunate

• Most commonly dislocated carpal bone
• Causes deformity, pain, swelling, and decreased
  ROM
• Splint and refer
• Physician relocates

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Ganglion Cyst

• Fluid within the muscle sheath
• Treat with ice and activity modification
• Refer to physician if symptoms persist

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Gamekeepers Thumb

• Injury to the medial collateral ligament
• aka skiers thumb
• Usually caused by forced abduction
• Pain and swelling likely
• Treat with ice and splinting of medial aspect of
  thumb
• Should have x-ray

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Interphalangeal collateral ligament sprains

• jammed finger
• Often caused by finger hit by ball
• Swelling, pain, discoloration
• May refer for x-ray
• Ice, buddy tape, possible padding

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Dislocations of ICP or MCP joints

• One bone usually moves volar (palm side), and one
  dorsal
• Refer to physician for relocation because of tiny
  tendons, nerves and blood vessel movement
• Improper relocation can cause permanent damage

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Tendinitis

• Inflammation of tendon
• Caused by overuse, stretching or impact
• Prevent by increasing strength and flexibility

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De Quervains tendinitis

• Affects abductor pollicis longus and extensor
  pollicis brevis
• Shot-putters are vulnerable
• Difficulty abducting, swelling, crepitis
• Limit activity, PRICE

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Mallet finger

• Result of direct impact
• Caused by tearing of extensor tendon from bone
• Cannot extend tip of finger due to tendon
  disruption
• Pain, swelling, need to splint in extension and
  refer
• Possible treatment- sugery or splint
• If not treated, finger will remain in permanent
  flexion

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Jersey finger

• Similar to mallet finger except injury it to
  flexor tendon
• Inability to flex DIP joint
• Named from moi, holding jersey with fist and
  finger forced to extend, tearing tendon
• Causes pain and swelling
• Splint, ice, and refer

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Boutonniere deformity

• Occurs at PIP join
• Caused by hard impact over PIP, results in tear
  in the joint capsule, extensor tendons fall
  laterally
• Extensors contract and force flexion of the PIP
  and extension of DIP
• Pain and swelling
• Splint and refer
• Continued splint or surgery are treatments

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Scaphoid fracture

• Commonly caused by falling on outstretched hand
• Pain, swelling, decreased ROM
• Refer for x-ray
• Casting common
• Untreated or improperly treated can cause a
  non-union fracture and/or avascular neucrosis

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Complications of scaphoid fracture

• Avascular neucrosis
• lower half of the fractured bone loses its blood
  supply and actually dies
• Can eventually lead to degenerative arthritis
• Non-union fracture
• If fx does not heal properly, surgery may be
  required

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Boxers fracture
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Boxers fracture

• most common type of metacarpal fracture
• point of maximal tenderness is just proximal to
  the knuckle
• Caused by direct blow/punch
• Ice, splint, and refer

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Colles fracture

• caused by falling forward onto an outstretched
  arm
• sometimes called a 'dinner fork
• Splint and refer for x-ray and treatment

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Smiths fracture

• Similar to Colles fracture, but wrist in flexion
• patient lands with the wrist in flexion

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Carpal tunnel syndrome

• caused when too much pressure is put on the
  median nerve
• Check with Tinels test or Phalens test
• Refer to physician for recommended treatment